Otitis Media and PE Tubes

Middle Ear infections (Otitis Media)

Infections can occur in the three different parts of the ear: external, middle, and inner. Otitis media, sometimes known as a middle ear infection, is an inflammation or infection in the space behind the eardrum known as the middle ear.   

Otitis media occurs most often in children. However, adults may also experience this condition.

Types of Otitis Media

Acute Otitis Media

This type of ear infection comes on quickly usually within 24-48 hours and has a relatively short duration. This type of infection is usually accompanied by swelling and redness in the ear behind and around the eardrum. 

Serous Otitis Media or Otitis Media with Effusion

After an acute episode of otitis media goes away, sometimes mucus and fluid will continue to build up in the middle ear. This can cause the feeling of fullness in the ear and affect the ability to hear clearly. The buildup of fluid that is secreted from the inflamed mucous membrane can be temporary with no signs of infection or chronic.

Chronic Otitis Media with Effusion

Occasionally serous otitis media can become chronic (present for 6 weeks or longer). Although there is no infection present, the fluid can remain in the middle ear for a prolonged period of time or return repeatedly. The longer the fluid remains in the middle ear, the thicker the fluid becomes.

Signs and Symptoms of Otitis Media

• Ear pain
• Drainage of fluid from ear
• Difficulty hearing
• Headache
• Fever of 100℉ or higher

More signs to look for in children:

• Fussiness
• Loss of appetite
• Tugging or pulling at an ear
• Crying more than usual 
• Trouble sleeping

Causes

Ear infections are caused by a bacterium or virus in the middle ear. The infection is often linked to another illness such as a cold, flu, or allergies, which in turn causes swelling of the nasal passages, throat, and eustachian tubes. 

The eustachian tubes are a pair of narrow tubes that run from each middle ear to high in the back of the throat, behind the nasal passages. The throat end of the tubes open and close. The opening and closing of the eustachian tubes regulate air pressure in the middle ear and drain normal secretions from the middle ear. If the eustachian tubes become swollen or blocked, fluids can build up in the middle ear space, which can then become infected and cause an ear infection. In children, the eustachian tubes are narrower and more horizontal, which makes them more difficult to drain and more likely to get clogged.

The adenoids, which are two small pads of tissues high in the back of the nose, may also contribute to middle ear infections. Because the adenoids are near the opening of the eustachian tubes, swelling may block the tubes. This can lead to middle ear infection. Swelling and irritation of adenoids is more likely to play a role in ear infections in children because children have relatively larger adenoids compared to adults.

Treatment

Wait-and-See Approach

Some ear infections may resolve on their own without treatment. Symptoms of ear infections usually improve within the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. This approach is most often used when symptoms are mild and there is no fever. Over-the-counter pain medications and/or anesthetic drops may be advised to help relieve pain. Some evidence suggests that treatment with antibiotics might be helpful with ear infections. On the other hand, using antibiotics too often can cause bacteria to become resistant to the medicine. Therefore, it is important to speak with a doctor about the potential benefits and risks of using antibiotics.

Antibiotics

After an initial observation period, antibiotic treatment may be recommended for an ear infection. Children younger than 6 months of age with confirmed acute otitis media are more likely to be treated with antibiotics without the initial observational waiting time. Even after symptoms have improved, be sure to use the antibiotic as directed. Failing to take all the medicine can lead to recurring infection and resistance of bacteria to antibiotic medications.

Ear Tubes

PE or pressure equalization tubes may be recommended for repeated, long-term ear infections (chronic otitis media) or continuous fluid buildup in the ear after an infection cleared up (otitis media with effusion). Tube placement usually involves an outpatient surgery where a procedure called a myringotomy is performed. The surgeon creates a small hole in the eardrum which enables him/her to suction out any fluid from the middle ear space. Next, a tiny tube (tympanostomy tube) is placed in the opening to help ventilate the middle ear and prevent the buildup of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed. The eardrum usually closes up again after the tube falls out or is removed.

It is important to monitor ear infections and reach out to a medical professional for treatment so as to avoid any permanent damage to the ear and/or hearing.